泌尿男生殖系统淋巴瘤的临床特征及预后分析  

Clinical features and prognosis of lymphoma of the male urogenital system

作　　者：夏俊哲 朱熹[1] 郝钢跃[1] Xia Junzhe;Zhu Xi;Hao Gangyue(Department of Urology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,100050

出　　处：《中华泌尿外科杂志》2020年第4期292-296,共5页Chinese Journal of Urology

摘　　要：目的探讨泌尿男生殖系统淋巴瘤患者的临床特征,并对其预后进行分析。方法回顾性分析2014年8月至2019年8月北京友谊医院收治的9例泌尿男生殖系统淋巴瘤患者的临床资料。男5例,女4例。平均年龄62(50~69)岁。肿瘤位于肾脏3例,膀胱2例,睾丸4例。首发症状:肾肿瘤3例中2例为发热(1例伴腹痛及体重减轻),1例为体检发现肾盂占位;膀胱肿瘤1例为肉眼血尿伴腹痛,1例为尿急、尿痛;4例睾丸肿瘤均为睾丸无痛性肿大。5例行CT检查见低密度肿物伴轻中度强化,4例睾丸肿瘤行B超检查提示不规则、不均质肿块内见血流信号。术前诊断均为泌尿男生殖系统肿瘤。6例接受手术,3例行病灶穿刺获取病理。9例中4例接受手术治疗联合化疗,2例仅接受化疗,2例仅接受手术治疗,1例未治疗。肾肿瘤3例中,1例行B超引导下病灶穿刺活检术,术后予环磷酰胺+阿霉素+长春新碱+泼尼松+利妥昔单抗(R-CHOP)方案静脉化疗;1例肾盂占位性病变者行腹腔镜肾输尿管全长切除术,术后予R-CHOP方案静脉化疗;1例行B超引导下病灶穿刺活检术,术后患者拒绝进一步治疗。2例膀胱肿瘤者均行TURBT,术后均拒绝放化疗。4例睾丸肿瘤者中,3例行患侧睾丸切除术,1例行B超引导下病灶穿刺活检术;3例行R-CHOP方案化疗,1例于外院行化疗及对侧睾丸放疗,具体方案不详;4例均行鞘内注射化疗药物(甲氨蝶呤15 mg+阿糖胞苷50 mg+地塞米松5 mg)预防中枢神经系统浸润。结果本组9例术后恢复顺利,无手术及穿刺相关并发症发生。术后病理诊断均为非霍奇金淋巴瘤,其中8例为弥漫性大B细胞淋巴瘤,1例睾丸淋巴瘤为间变性大细胞淋巴瘤。按照Ann Arbor分期标准进行临床分期,确诊时Ⅰ~ⅡE期4例,ⅢE~ⅣE期5例。国际预后指数(IPI)评分0~2分6例,≥3分3例。随访时间平均18(6~66)个月。7例存活,其中3例完成化疗者中,2例完全缓解(睾丸淋巴瘤ⅡE期IPI�Objective To discuss the clinical features of lymphoma of the male urogentioal system.Methods The clinical data of 9 patients in Beijing Friendship Hospital from August 2014 to August 2019 reviewed,including 5 males and 4 females.The mean age of those patients was 62 years,range from 50 to 69.3 cases were diagnosed as renal tumor,2 cases were diagnosed as bladder tumor and 4 cases were testicular tumor.2 cases of the renal tumor presented with fever primarily(1 case with abdominal pain and weight loss),1 case was found renal pelvis tumor in medical checkup.1 case of bladder lesions suffered from gross hematuria with abdominal pain and the other case with urinary frequency and urgency.All of the 4 testicular tumor cases were admitted to hospital with painless testicle mass.5 cases were examined by CT showed low density mass with mild to moderate enhanced.Testicular tumors were detected by ultrasound showed irregular and heterogeneous mass with blood flow signals in them.4 cases received operation and chemotherapy,2 cases only received chemotherapy,2 cases only received operation and 1 case didn’t receive further treatment.1 case of 3 renal tumor cases received ultrasound-guided tumor biopsy and accepted rituximab plus cyclophosphamide,doxorubicin,vincristine and prednisone(R-CHOP)chemotherapy.1 renal pelvis tumor patient received laparoscopic nephroureterectomy and R-CHOP chemotherapy.1 case received ultrasound-guided tumor biopsy and refused further treatment.Both of two bladder tumor patients accepted TURBT and refused radiotherapy and chemotherapy.For 4 testicular tumor cases,3 patients received orchiectomy and 1 patient received ultrasound-guided tumor biopsy.3 cases accepted R-CHOP chemotherapy,1 case received chemotherapy and contralateral testis irradiation(specific proposals unknown).All of 4 cases received CNS prophylaxis by intrathecal injection(methotrexate 15mg,cytarabine 50 mg and dexamethasone 5 mg).Results All 9 cases who received surgery or biopsy recovered favorably,no complications were found.T

关 键 词：泌尿系疾病 男性泌尿生殖系统 淋巴瘤 诊断 预后 

分 类 号：R737[医药卫生—肿瘤]